In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Colombians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some important, albeit insufficient, responses. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. Doing so is not an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.

External evaluation of analytical quality in hematology: a necessity in Latin America Artículos

The assurance of analytical quality in a clinical laboratory is achieved through an internal system of quality control complemented by an external evaluation program. Quality assurance provides a foundation for the confidence that is placed in laboratory results and their use in the diagnosis and treatment of diseases. Many laboratories in Latin American countries do not have appropriate systems in place to evaluate and control quality. Given the importance of diagnoses based on hematologic data, the Pan American Health Organization sponsored a course in quality control in hematology during the XI Latin American Congress of Clinical Biochemistry (Mexico, 1993), in which representatives from Argentina, Chile, Cuba, Mexico, Paraguay, Dominican Republic, and Uruguay participated. As part of the course, the following control materials were produced: secondary standard solution of cyanmethemoglobin, stabilized concentrated hemoglobin solution, and preserved human whole blood with pseudoleukocytes. These materials were sent to laboratories in the seven participating countries for use in analytical procedures, and the results were then subjected to an external evaluation to assess individual performance and the comparability of results among the group. The specific tasks carried out were: (1) determination of values for hemoglobin, hematocrit, and red and white blood cell counts by the procedures normally used in each laboratory; (2) recording of the data on special reporting forms; and (3) transmittal of those forms to the coordinator in each country. The results were analyzed with regard to both the procedure used and the participating country. Reference values were established by consensus following application of a statistical method to eliminate outlying values. Comparative analysis of the results showed the coefficients of variation (CV) of the hematocrit (4.5%), red blood cell count (11.0%), and white blood cell count (22.2%) to be higher than those reported from the United States of America and Europe. With regard to analytical procedures, the manual methods yielded larger CV than the automated methods. When analysis of variance (ANOVA) was used on data broken down by country and by procedure, the only statistically significant result was for leukocyte count (P < 0.02). It was concluded that training in the preparation of quality control materials and the subsequent use of these materials in pilot surveys could provide a starting point for establishing continuous internal and external quality assessment systems in hematology. Such systems, together with continuing education for laboratory personnel and the availablity of automated instrumentation, will lead to achievement of optimum laboratory quality.

Infection of Anopheles (Kerteszia) cruzii with Plasmodium vivax and Plasmodium vivax variant VK247 in the municipalities of São Vicente and Juquitiba, São Paulo

Sporadic cases of autochthonous malaria have been recorded in São Paulo State, located in the Southeast region of Brazil. These cases are characterized by their benign course, low parasitemia, and mild symptomatology and have been identified as vivax malaria. Little is known about the symptoms and immune response elicited in humans by the variants Plasmodium vivax VK247 and P. vivax-like human malaria parasites. These variants are transmitted by Anopheles (Kerteszia) cruzii, one of the most common species of mosquitoes in the Southeast of Brazil. The objective of the study described in this paper was to investigate infection in anophelines using ELISA immunoenzymatic assay with specific monoclonal antibodies directed against the repetitive regions of the circumsporozoite protein in classic P. vivax, P. brasilianum/P. malariae, and P. vivax VK247. Between 1991 and 1993, mosquitoes were collected in São Vicente and Juquitiba, municipalites located in a remnant of the Brazilian Atlantic forest in São Paulo State, an ecosystem rich in plants of the Bromeliaceae family. These plants function as nurseries for immature forms of anophelines of the subgenus Kerteszia. Of 1117 An. (Ker.) cruzii captured in São Vicente, 0.179% were positive for classic P. vivax. In Juquitiba, of 1161 An. (Ker.) cruzii, 0.086% were positive for P. vivax VK247, confirming the presence of this variant in the region. Although the infection rate is low, the high density of these mosquitoes and their voracity (they exhibit 24-h biting activity) could compensate for the low percentage of infected specimens.

Dental care associated with an outbreak of HIV infection among dialysis patients Articles

An outbreak of 14 cases of human immunodeficiency virus (HIV) infection was discovered by chance in May 1993 among hemodialysis patients at a university hospital in Bucaramanga, Colombia. The outbreak occurred in 1992. Stored sera were used to establish the probable period of infection (PPI) for 10 of the 14 cases. A nested case-control study was carried out to evaluate possible transmission mechanisms. The health care experience of each HIV-positive patient during that patients PPI was compared to the experience of time-matched controls. Only invasive dental procedures were significantly associated with the risk of infection. Patients upon whom invasive dental procedures were performed during their PPIs had an average risk of HIV infection 8.15 times greater than comparable controls (P = 0.006), and seven out of nine cases of HIV infection with known PPIs in 1992 had an invasive dental procedure performed one to six months before seroconversion. None of the dental care personnel were found to be infected. Based on the available evidence, it seems most likely that the infection was transmitted from patient to patient by contaminated dental instruments.

La salud del niño en edad escolar Instantáneas

Educational components of school health promotion programs Temas de Actualidad

To implement an education initiative on school health in the Region, PAHO and other agencies will disseminate knowledge and experiences to schools in various countries throughout the Americas, organize meetings and workshops for the purpose of strengthening institutional capacity to identify the needs of local health education systems, and put into practice strategies to promote health and strengthen schools involvement in this area. To determine a countrys ability to set up and evaluate school health programs, the rapid assessment and analysis methodology will be used. This methodology, which arose in response to the need of governments to make decisions, formulate policies, and design programs on the basis of knowledge of the individual and collective behavior of their beneficiaries, is a useful tool for decision making and facilitates coordination mechanisms between the health and education sectors. In addition, it contributes quantitative and qualitative information for program review and analysis in an average of two months. This information is obtained through the compilation of data from secondary sources, interviews with key informants, and discussions with focal groups made up of formal and informal community leaders.

Virtual elimination of iodine deficiency disorders in Bolivia Current Topics

VI Ibero-American Summit of Heads of State and Government: Declaration of Viña del Mar Temas de Actualidad

The leaders of 21 Ibero-American countries came to Viña del Mar (Chile) for the sixth meeting of the now-traditional Ibero-American Summits. The Declaration that resulted from the Summit reiterated the commitment of these nations to the principles of democracy, the rule of law, and political pluralism. The development of efficient and participatory systems of democratic government was one of the most important of the topics dealt with at the meeting and served as the framework for the discussion and the search for solutions to common problems, such as poverty, arms trafficking, unequal opportunity for men and women, and inappropriate government practices. The leaders also supported a series of initiatives and international programs in the technological and cultural arenas that will strengthen the ties and unite the Spanish- and Portuguese-speaking countries.